以實證依據建立成人急性腸胃道移植物抗宿主疾病臨床照護指引

Establishment of Evidence-Based Clinical Care Guidelines for Adult Patients with Acute Gastrointestinal Graft-Versus-Host Disease

背景：急性移植物抗宿主疾病為異體造血幹細胞移植常見的併發症之一，其發生率約為39%至59%，當腸胃道受侵犯時，患者常會出現嚴重腹瀉及營養不良情形，並顯著增加死亡風險。
目的：本研究旨在建構具實證基礎之「成人急性腸胃道移植物抗宿主疾病臨床照護指引」，以提供實務應用之依據。
方法：本研究採用四階段設計，第一階段，籌組專家小組；第二階段，確定關鍵字並搜尋電子資料庫，依JBI（Joanna Briggs Institute）系統性文獻評析與證據萃取；第三階段，透過專家共識會議彙整意見並擬定指引初稿；第四階段，透過問卷調查方式評估指引之可行性與內容效度。
結果：研究團隊最終建構出40項的實證照護建議，涵蓋三大領域：1.範圍界定5項；2.評估方法10項；3.處置策略25項。
結論：本臨床照護指引可作為醫護人員於照護成人急性腸胃道移植物抗宿主疾病患者時之實務參考，有助於減緩該疾病患者的身心、社會與靈性層面之衝擊，並透過營養補充提高其存活率。

Background: Acute graft-versus-host disease (aGvHD) is among the most common complications following allogeneic hematopoietic stem cell transplantation, with an incidence rate ranging from 39% to 59%. Patients with gastrointestinal involvement often experience severe diarrhea and malnutrition, substantially increasing the risk of mortality.
Purpose: This study aimed to develop evidence-based clinical care guidelines for adult patients with acute gastrointestinal graft-versus-host disease, providing a foundation for standardized clinical practice.
Methods: A four-phase design was adopted. In Phase I, an expert panel was established. In Phase II, relevant keywords were identified, and electronic databases were systematically searched. Literature was appraised according to the Joanna Briggs Institute (JBI) methodology for evidence synthesis, and key evidence was extracted. In Phase III, expert consensus meetings were conducted to compile expert opinions and draft the initial version of the guidelines. In Phase IV, the feasibility and content validity of the guidelines were evaluated using a structured questionnaire.
Results: The research team developed 40 evidence-based care recommendations, organized into three major domains: (1) Scope Definition (5 items), (2) Assessment Methods (10 items), and (3) Management Strategies (25 items).
Conclusions: These clinical care guidelines provide a comprehensive reference for healthcare professionals involved in the care of adult patients with acute gastrointestinal graft-versus-host disease. Implementation of these recommendations may help mitigate the physical, psychological, social, and spiritual burdens of the disease, while improving nutritional status and overall survival outcomes.